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Indigenous healthcare facility design, a conversation (Part 2)

Three healthcare designers discuss considerations such as connection to place and sustainability

Stantec designs healthcare facilities globally. In Canada, this often gives us an opportunity to collaborate with communities that include First Nations, Inuit, and Métis peoples. Recently, we gathered three architects who presented on the topic at the RAIC conference to talk about their experience working on healthcare projects for indigenous populations in urban, rural, and remote contexts. Our panelists include:

Vlad: Sustainability is very much part of the indigenous culture. Our current project has to be LEED Gold, it’s in an area where this is mandated. So orientation and taking advantage of two faces of building are important in mitigating the heating and cooling needs. But our client is exploring going further, we’re looking at the possibility of reaching Net Zero and there appears to be political support and hopefully funding for this goal. Stantec has all this expertise on Net Zero, and we’re trying to take advantage of that.

Connection to the land?

Celeste: We are working in places that are very cold and experience long months of darkness in the winter, coupled with summers of sometimes 24-hour sunlight. A connection to place is very much a part of the culture. Where we locate buildings, how we orient them, how we take advantage of low sun angles to bring in natural light, placing entrances relative to prevailing winds and snow drifts. We are often given advice on this by the local residents, only to have their advice echoed by geotechnical experts or microclimate modeling.

Vlad: It is a fundamental issue for most cultures I have been privileged to work with. We are talking about a spiritual connection as well as a literal one: traditional ceremonies must occur in direct contact with the ground, no spaces such as basement or parking can be located underneath.

For many communities, a new healthcare facility will likely be the most significant building. Pictured is North Island Hospitals—Comox Valley Regional Hospital in Courtenay, British Columbia, on Vancouver Island.

Is the project a point of pride for the community?

Bruce: A new $250 million hospital in a community like Campbell River or Comox Valley is likely the most significant building that will ever be done in that community. Virtually everybody in that community will be impacted by it. It’s a lot different from putting a hospital in Toronto or Vancouver where they have dozens of hospitals and many projects of that scale are much larger. And everybody knows about it. From the moment you arrive, everybody has something to say about it.

Celeste: A community health center is one of the key buildings in the community, along with the school and hamlet office, and the community takes pride in it. More importantly, it is the first point of contact for any of the residents to enter the healthcare system. They may see a healthcare worker in the far reaches of the North and could end up in a city-center for more complex care. It’s a hierarchical system of care, as your needs become more complex, you move to the next largest center and eventually are funneled down to southern Canada.

Having the local community members at the table and making them a part of the design discussion is important. It helps us tease out the subtleties of their needs and gives them a sense of ownership. That’s the goal.

Construction challenges above the 60th parallel include a limited window for shipping materials and construction on permafrost.

What were the logistical challenges of designing and building in a remote location?

Celeste: Construction and materials shipping is very challenging in these remote areas. Many of the communities we work in are not connected by road. This means we are relying on ice roads in winter to take us to the further reaches of the territory, or relying on barges to transport building materials over water, which means having shipments ready for a very limited window. It requires careful planning. Flying in materials is very expensive.

It’s interesting to be in the community when the barge arrives. Most families get their year’s supply of non-perishables on a barge, as well as building materials, vehicles, anything at all.

This figures in the design of the health centers, as they need enough storage space to accommodate a year’s worth of storage on site for their paper products and other materials. Much of what is needed to operate that facility will arrive once a year on a barge.

Vlad: Sioux Lookout is served by only one electrical line. The hospital has to plan for days of relying on generators in the event of the line going down during a forest fire.

What kind of professional satisfaction do you get from these projects?

Vlad: It’s extremely fulfilling to be able to—with humility—say we understand a bit of that culture without being indigenous ourselves. We try to apply the approach of truly listening to the community and distill the meaning of the place. When that cultural resonance is achieved the fulfilment goes well beyond the normal pleasure of the work well done.

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From the Design Quarterly: Bridging cultures to create buildings for unique populations

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